TMS-EEG Correlate of Suicidal Ideation in Individuals with Depression: A Multi-Site Synthesis.

One local EEG response after a TMS pulse was associated with greater suicidal-ideation severity. This is a research finding, not a clinical test, prediction tool or evidence that TMS treats suicidal ideation.

Stapper N, Sun Y, Poorganji M, Dhami P, Hadas I, Bailey NW, Kaewpijit P, Zomorrodi R, Kohn JN, Fitzgerald PB, Farzan F, Rodriguez FV, Downar J, Blumberger DM, Appelbaum LG, Daskalakis ZJ, Weissman CR.
Brain stimulation · Publication date: 2026-09-12
Added to site: 2026-09-15
DOI: 10.1016/j.brs.2026.103206

First electronic publication date from the authoritative index; the September issue date is less precise.

Modalities

EEG, TMS

Clinical focus

Depression, Suicidal ideation

Population

Adults with major depressive disorder and at least one ineffective antidepressant trial

Sample

299 adults across five academic medical centers

Intervention / method

Single-pulse TMS to the left dorsolateral prefrontal cortex with simultaneous EEG; local N100 and global mean-field measures analyzed

Comparator

Association across suicidal-ideation severity; no sham TMS condition

Clinician summary

More negative left-DLPFC N100 amplitude was associated with greater ideation severity after covariate adjustment (OR 1.52, 95% CI 1.17 to 1.98); the global mean-field measure was not significant.

How to interpret the findings

Cross-sectional association cannot establish causation or predictive accuracy. Sham TMS-EEG validation and prospective testing are required before biomarker use.

Equipment and disclosures

TMS and EEG equipment details were not verified from the reviewed abstract. No BrainMaster equipment attribution.

Funding and conflicts were unavailable in the reviewed abstract.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Repetitive transcranial magnetic stimulation (rTMS) combined with antidepressant pharmacotherapy for depression: state-dependent mechanisms, clinical evidence, and translational challenges · Positive with limitations
• Intermittent theta‐burst stimulation versus sham stimulation for suicidal ideation and psychiatric symptoms in depressive disorders: A systematic review and meta‐analysis of randomized controlled trials · Positive with limitations
• Transcranial low voltage pulsed electromagnetic fields in patients with treatment-resistant depression. · Positive with limitations
• The effects of swLORETA Z-score neurofeedback for patients comorbid with major depressive disorder and anxiety symptoms. · Positive with limitations
• Effects of swLORETA Z-score neurofeedback in Z-coherence of the fronto-limbic circuit in patients with major depressive disorder. · Positive with limitations
• Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. · Positive with limitations
• Clinical Efficacy of High-Frequency Deep Repetitive Transcranial Magnetic Stimulation in the Treatment of Depression and the Predictive Role of Baseline Triglyceride Levels: A Randomized Sham-Controlled Trial. · Positive with limitations
• Motor Cortex rTMS Alleviates Pain and Comorbid Depression After Spinal Cord Injury with a Correlate in M1 Intracortical Inhibition. · Positive with limitations
• A PRISMA-compliant Systematic Review and Meta-Analysis of the Late Positive Potential in Depression. · Positive with limitations
• Feasibility, tolerability, and preliminary effectiveness of an accelerated bilateral intermittent theta-burst stimulation protocol in adults with posttraumatic stress disorder and comorbid depressive disorder following mild traumatic brain injury. · Positive with limitations
• Accelerated TMS is associated with changes of subgenual cingulate-default mode network coupling in depression: an observational 7 Tesla fMRI study. · Mixed
• Identifying poor responders to repetitive transcranial magnetic stimulation using structural brain networks. · Positive with limitations
• Theta burst stimulation with 80 and 120% resting motor threshold do not differ in their antidepressant efficacy: a retrospective analysis. · Positive with limitations
• TMS-Evoked Cortical Reactivity Signatures as a Multidimensional Biomarker of Depression: A TMS-EEG Meta-Analysis from Diagnosis to Prognosis. · Positive with limitations
• The effects of cognitive-behavioural therapy (CBT) on heart rate variability (HRV) in people with depression and/or anxiety disorders: A systematic review and meta-analysis · Positive with limitations